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random questions Flashcards

1
Q

WHO definition of osteoporosis

A

Being outside the 2.5 x standard deviation of that age group

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2
Q

RF for osteoporosis

A

Oestrogen deficiency
Vit D insufficiency
Hyperparathyroidism

Smoking
Alcohol
Previous fracture

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3
Q

What is Ehlers Danlos syndrome?

A

Multi system connective tissue disorder characterised by abnormal collagen in skin, joints, blood vessels causing fragile vessels and elastic bones

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4
Q

In back pain, differentiate MSK from referred

A

MSK pain is mostly lumbar
Short-lived
Sudden
Relieved by rest

Referred is mostly thoracic
Constant and progressive

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5
Q

Difference between sepsis and septic shock

A

Severe sepsis shows organ dysfunction

Septic shock also has hypotension

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6
Q

What are the effects of persistant proteinuria in nephrotic syndrome

A

Loss of IgG - susceptibility to infection
Loss of coagulation inhibitors - hypercoagulability
Loss of apoproteins - Hyperlipidaemia

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7
Q

What are secondary causes of nephrotic syndrome

A

DM
SLE

Heroin
Malaria
Hepatitis
HIV
NSAIDs
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8
Q

Constituents and purpose of saline solution (0.9%)

A

Na 154mmol
Cl 154 mmol

Expands extracellular H2O

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9
Q

Constituents and purpose of Hartmann’s solution

A 
130 Na
109 Cl
4 K
1.5 Ca
28 Lactate

Normalises pH if acidic

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10
Q

Constituents and purpose of 5% Dextrose solution

A

50g dextrose in 1 L H2O.

Expands body water, slightly more towards extracellular (CRYSTALLOID)

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11
Q

Constituents and purpose of Abumin solution

A

150 Na
136 Cl
<2 K
40-50 g Albumin

Extracellular volume expander (COLLOID)

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12
Q

What is used in the treatment of paracetamol overdose

A

N-acetylcysteine
Within 8-10 hours
Measure paracetamol plasma concentration to decide whether to treat or not

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13
Q

Causes of microcytic anaemia

A 
TAILS
Thalaessemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia
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14
Q

Causes of normocytic anaemia

A

Acute blood loss
Haemolytic anaemia
CKD

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15
Q

Causes of macrocytic anaemia (megaloblastic)

A 
Folate deficiency (alcoholics, haemolysis, pregnancy)
B12 deficiency (vegetarians, pernicious anaemia, disease of terminal ileum such as Crohn's)
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16
Q

Character of bacterial meningitis

A 
CSF:
Turbid, purulent
Marked increase in polymorphs
Some increase in protein. 
<50% of blood glucose

There is a higher risk of complications with bacterial meningitis.

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17
Q

Which patients are at risk of subdural haemorrhage?

A

Elderly and alcoholics. Patients on anticagulants.

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18
Q

How does subdural haemorrhage present.

A

Long prodrome, may be weeks after a trauma until S&S.
Headache, drowsiness, confusion. Focal neurological deficits. Epilepsy. Stupor, coma.

Pressure atrophy of the brain because of fluid between dura and arachnoid.

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19
Q

Whar are differentials for stroke?

A

Hypoglycaemia
Tumour
Seizure

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20
Q

What is the triad of meningism?

A

Photophobia
Headache
Neck stiffness

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21
Q

Which scrotal swellings have associations with tumours and which don’t?

A

Hydrocele has association with tumour.
Also with infection and trauma.

Spermatocele has no association with tumour.

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22
Q

How many lumps can a hydrocele be?

A

more than 2 (because of association with tumours?)

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23
Q

How many lumps can a spermatocele be

A

only 1

24
Q

Which factor indicates acute over chronic hepatitis

A

Raised WCC

25
Q

What is the triad in nephrotic syndrome

A

proteinurea
hypoalbuminaemia
hyperlipidaemia
Oedema

26
Q

What are the symptoms of autosomal PCKD

A

Haematuria
Bilateral palpable kidneys
Flank pain
Systemic disease (hernias, stones, HTN)

27
Q

What is often the first indicator of liver damage in paracetamol overdose

A

Prothrombin time (INR)

28
Q

What is achalasia

A

Oesophagus loses motility. Also, the valve at the GOJ does not open properly. Leads to food spillover into lungs.
Some relief from dysphagia during eating.

29
Q

What is the commonest cause of nephropathy?

A

IgA nephropathy. Leads to concurrent URTIs.

Thin basement membrane disease.

30
Q

What is the likely diagnosis if a patient has elevated serum urea but only mildly elevated creatinine?

A

Dehydration

31
Q

What are the criteria for glomerular nephropathy

A

haematuria
proteinuria
hypertension

32
Q

What is Stevens Johnson Syndrome

A

Rash on arms, leg, face.
Ulceration of lips and mouth.

Caused by acute drug sensitivity. Most commonly to antibiotics

33
Q

Which factors in acute meningitis are suggestive of bacterial origin?

A

Hypotension
Leucocytosis (neutrophilia)
Renal impairment

34
Q

What are causes of hyponatraemia

A

Often due to excess loss of fluid - sweating, diarrhoea, vomiting, burn.

Diuretics and Addison’s lead to renal loss of Na and H2O.

Hyponatraemia with hypovolaemia occurs with excess retention of water. (eg severe kidney failure).
SIADH (malignancy, neurological, or pneumonia).

With normovolamia - administration of too much IV hypotonic fluid.

35
Q

How to rule out a subdural haematoma?

A

CT

36
Q

What ar the key clinical features of diabetic ketoacidosis

A

Hyperventilation

Dehydration (there is high serum K)

37
Q

What is suggested by an ABPI of <0.97

A

Arterial disease in the leg

38
Q

Which extrarenal clinical features can point towards the cause of ARF

A

Lung basement membranes can be affected in Goodpasture’s.
Microvascular signs in eyes in DM/HTN.
Hepatorenal syndrome.
There may be signs of infection, if that is the cause.
Muscle pain in rhabdomyolysis.

Heart failure and endocarditis may be present.

39
Q

Symptoms of pancreatic cancer in the body or tail.

A

Thrombophlebitis migrans (femoral vv, legs, arms - swollen and red).
Anorexia.
Pain radiating to back, relieved by sitting forward.
Acute pancreatitis, late onset DM.

40
Q

Signs of pancreatic cancer

A 
Jaundice
Severe weight loss
Palpable masses
Palpable gall bladder
Lymphadenopathy
Ascites

Signs relating to liver metastasis indicate worse prognosis (eg. low albumin).

41
Q

Symptoms of bladder TCC

A

Sterile pyuria
Painless haematuria
UTIs
Obstructive symptoms

42
Q

Suprapubic pain relieved by lying down

A

Bladder calculi

43
Q

The symptoms of adenocarcinoma of the prostate

A

Back pain
Weight loss
Anaemia

Progressive urinary tract obstruction.q

44
Q

RF for renal calculi

A

Metabolic - acidic/alkalic urine
Infection
Dehydration
High Calcium in the diet

45
Q

What are distinctions in the symptoms of lower and upper UTIs

A

Upper - loin pain, tenderness, fever, rigors.

Lower - suprapubic pain, frequency, dysuria

46
Q

What is the indication of AXR in upper UTI diagnosis?

A

Shows most renal stones

47
Q

Which sensations are lost first in diabetic symmetrical distal sensorymotor polyneuropathy?

A

“Walking on a cotton wool”

Vibration
Temp
Pain sensation

48
Q

What is the pattern of callous formation in DM

A

Formation at the 1st metatarsal head.

Ulceration

49
Q

Which nerves are most commonly affected in diabetic mononeuropathy

A

CN3
CN6
Pupillary reflexes are maintained.

Carpal Tunnel syndrome is also more common.

50
Q

What is the aetiology of hyperthyroidism

A

80% Graves Disease
15% multinodular goitre
5% Solitary toxic adenomas

51
Q

What are the main features of diabetic nephropathy

A

Albuminuria
More in T1DM
Normochromic, normocytic anaemia.

Advice high protein diet.

52
Q

What are possible features of a malignant solitary nodule goitre?

A

Rapid enlargement.
LN enlargement.
Pain?

T3 toxicosis (production by adenoma).

53
Q

How do multinodular goitres present?

A

15% of Hyperthyroidism.
Can also be euthyroid.

RARE to be hypothyroid or Malignant.

Local effects (laryngeal nn palsy, tracheal/oesophageal compression)

54
Q

Which hormones can be secreted by tumours in the lungs?

A

ACTH
ADH (dilutional hyponatraemia)
PTH (hypercalcaemia)

55
Q

What is a Pancoast tumour?

A

Invasive lung tumour near brachial plexus.

Pain radiating down to hands, muscle wasting.

56
Q

What is Horner’s syndrome?

A 
Lung tumour compresses sympathetic nerves.
Triad of:
Miosis
Hemifacial ptosis
Hemifacial anhidrosis

CP1 (6 decks)

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